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Geographic Variations in Health Care

What Do We Know and What Can Be Done to Improve Health System Performance?

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Variations in health care use within a country are complicated. In some cases they may reflect differences in health needs, in patient preferences or in the diffusion of a therapeutic innovation; in others they may not. There is evidence that some of the observed variations are unwarranted, signalling under- or over-provision of health services, or both. This study documents geographic variations for high-cost and high-volume procedures in select OECD countries. It finds that there are wide variations not only across countries, but within them as well. A mix of patient preferences and physician practice styles likely play an important part in this, but what part of the observed variations reflects over-provision, or whether there are unmet needs, remain largely unexplained. This report helps policy makers better understand the issues and challenges around geographic variations in health care provision and considers the policy options.

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Portugal: Geographic variations in health care

During the eight-year period covered in this report (2002-09), there has been a reduction in geographic variations in the use of some of the health care procedures selected in this study, such as cardiac catheterisation and coronary angioplasty. There has also been a reduction in geographic variations in caesarean section rates, although the variation between public and private hospitals rates continues to be wide. The Portuguese Ministry of Health recently asked a group of experts to develop a plan to reduce the inappropriate use of caesarean sections throughout the country.

This study also shows that geographic variations in the use of some other procedures that are becoming less frequently used and replaced by other treatment options are increasing, for example for coronary artery bypass graft (CABG) and hysterectomy. This indicates that the reduction in the use of these procedures has not been uniform across the countries, and a need to promote greater convergence in clinical practices.

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